Monday, March 16, 2009

News Clipping Archives

 

Maryland / Regional

Physician shortages growing concern in state’s rural areas (Cumberland Times-News)

Rawlings-Blake withdraws support for group home measure (Baltimore Sun)

Fewer teens sniffing inhalants to get high (Washington Times)

Poultry farmers upset at new EPA rules (Annapolis Capital)

National / International

Untreated adult ADHD raises some risks (Baltimore Sun)

Treatment for Peanut Allergies Shows Promise (New York Times)

Analysis: Stem cell payoff wait's decades not days (Washington Post)

Possible therapy takes bite out of peanut allergy (Washington Post)

Opinion

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Maryland / Regional

 

Physician shortages growing concern in state’s rural areas

 

Cumberland Times-News

Monday, March 16, 2009

 

OAKLAND — With 50 percent of Garrett County’s physician group eligible for retirement within the next 10 years, members of the Maryland Rural Caucus are concerned with the growing shortage of physicians in the state’s rural areas.

 

Health care leaders and representatives of various rural Maryland counties, The Greater Cumberland Committee, Greater Salisbury Committee and Maryland Medical Society met recently with the caucus.

 

Donald Battista, president/CEO of Garrett County Memorial Hospital, presented a forecast of physician needs in the county over the next five to 10 years. This prediction included concerns in regard to the domino effect the looming doctor shortage could have on both the county’s economic development and its medical services.

 

Battista said new physicians typically do not seek out Maryland to establish practices. Many other states offer extensive medical loan forgiveness; have dramatically better medical malpractice climates; provide higher levels of physician reimbursement; and offer monetary practice assistance and incentives to stabilize the community’s medical needs and encourage physicians to set up practices.

 

Rural Maryland counties simply do not have those resources available, and may therefore be at a recruiting disadvantage in the future.

 

Several bills are being considered in Annapolis that would use state resources to increase the number of medical school and residency slots so Maryland schools can begin producing more physician graduates. Other bills include inducements for keeping more Maryland medical school graduates in the state and incentives for agreeing to practice in rural areas.

 

“State government understands the need to ensure a sufficient number of physicians in Maryland and they are being very proactive to prevent a crisis from occurring,” Battista said. “The Western Maryland delegation, as well as the Maryland Rural Caucus, is keenly aware of the importance of this issue and they are doing everything possible to ensure all areas of the state, especially rural counties, maintain an adequate supply of physicians and other health professionals into the future.”

 

Maryland Rural Caucus is chaired by Delegate Leroy Myers and includes Sen. George Edwards, Delegate Wendell Beitzel and 43 additional legislators from Southern Maryland and other non-urban districts around the state. The caucus exists to ensure rural counties consider legislation unique to their constituents.

 

Colleen Peterson, executive director of The Greater Cumberland Committee, and Dr. Tom Chappell of Braddock Medical Group in Cumberland also attended the caucus meeting.

 

Copyright © 1999-2008 cnhi, inc.

 

Rawlings-Blake withdraws support for group home measure

City Council president's decision could trigger federal lawsuit

 

By Annie Linskey

Baltimore Sun

Monday, March 16, 2009

 

The head of the Baltimore City Council has withdrawn her support from an effort to streamline the opening of city group homes, a decision that could trigger a costly federal lawsuit.

 

Council President Stephanie C. Rawlings-Blake said she will not vote for legislation proposed by Mayor Sheila Dixon that would create more housing for drug addicts and other disabled people. The proposal, Rawlings-Blake said, "does not provide adequate safeguards for neighborhoods."

 

"I made some suggestions based on things I was hearing that would have made it more palatable, but it still was not palatable to many communities," she said. "It is a down economy, neighborhoods are fighting for stability. They are seeing this as one more thing that potentially weakens them."

 

While the City Council president has just one vote on legislation, her position is influential. Federal authorities wrote to Rawlings-Blake in December, saying that they don't believe the bill will pass without her support and that they will seek a civil rights lawsuit to bring the city's code in line with the Americans with Disabilities and Fair Housing acts.

 

Advocates, hoping to revive the legislation, plan to hold a rally in front of City Hall today.

 

Lawyers with the Department of Justice's civil rights division investigated the city's zoning code last year after advocates alleged in a legal complaint that city zoning creates undue hardships for those hoping to open state-licensed group homes because each project requires council approval.

 

Dixon, in December 2007, proposed legislation that would strip the City Council of the authority to veto licensed group homes, and federal authorities support the legislative fix. Unlicensed homes, which provide less care, do not require council approval.

 

The mayor says the cash-strapped city can ill afford defending against a federal suit and said failing to fix problems in the city's code is "very irresponsible."

 

"We've been back and forth on this group home issue for a number of years," Dixon said. She said the council needs to understand "the ramifications of what it is going to cost the city."

 

The controversy around the legislation can be measured by the size of the bill file in City Hall, which contains a 3-inch stack of legal analyses and letters from community groups - some of which support the change and some of which don't.

 

One public hearing last summer lasted five hours, and the sign-in sheet for those testifying ran to 11 pages.

 

Under Dixon's legislation, homes with eight or fewer clients could open in any city neighborhood.

 

Similar attempts to remove City Council authority when Martin O'Malley was mayor were unsuccessful.

 

Dixon's bill would allow homes treating people with all federally recognized disabilities to open without City Council approval.

 

The current law "is not defensible," said Ellen M. Weber, a law professor at the University of Maryland who has been advocating for seven years to change the city's zoning law. "You are saying that people with disabilities need to go though a separate standard."

 

Drug treatment advocates, who say there are waiting lists to get into current facilities, are also pushing the change. There are 25 such facilities, according to the Baltimore Health Department.

 

"Licensed drug treatment is part of the solution," said Dr. Joshua M. Sharfstein, the city's health commissioner. "It is not part of the problem."

 

He estimated that the bill would result in a "modest increase" in drug treatment facilities. "The thought that these would be popping up all over the place is completely fanciful," he said. "It would give more flexibility to the system."

 

Gale Saler, a director at a drug treatment nonprofit called Gaudenzia, described a laborious process for winning council approval when he wanted to open a new center in Northwest Baltimore. He picked a building in an industrial district that he called "a neighborhood dumping ground for old industrial parts and old cars," and he garnered support from the Abell Foundation, Weinberg Foundation, the mayor's office, the city Health Department and the council member who represented the place where he wanted to build a home. Still, it took a year for the necessary city legislation to pass.

 

But opponents worry that lifting council oversight would mean group homes would be clustered in a few city neighborhoods that have large, inexpensive housing stock.

 

Shadid Tamir Abdul-Rahim, a board member of the Howard Park Civic Association, lives on a block that contains two group homes. "Our community is going to become an institution," he said. Group home residents are unlikely to vote or participate in community civic life, he said. "The city should be concentrating on getting the professional to move back to the city so they can pay taxes," Abdul-Rahim said. Community activists in Lauraville also dislike the measure.

 

Such concerns are underlined by the city's uneven record of enforcing code complaints on the unlicensed facilities, Rawlings-Blake said. The administration offered to create a position for a citywide coordinator to hear complaints for licensed and unlicensed homes, but many council members are not convinced that would be adequate.

 

"Our constituents have to be convinced that once the legislation is in place it will be enforced," Rawlings-Blake said. "There are people who do not trust that their neighborhoods will be protected."

 

Copyright 2009 Baltimore Sun.

 

Fewer teens sniffing inhalants to get high

 

Associated Press

By Erica Werner

Washington Times

Monday, March 16, 2009

 

WASHINGTON (AP) - Fewer teens are sniffing glue, lighter fluid, spray paint, shoe polish and other easy-to-find substances, a government study said Monday.

 

But the study said the number of adolescents who actually abuse inhalants -as opposed to just trying them - remained stable between 2002 and 2007, suggesting the need for continued prevention and treatment efforts.

 

"Most parents don't realize how dangerous inhalants can be," said Ed Jurith, acting director of the Office of National Drug Control Policy. "These products _ found in every home in America - are among the most popular and deadly substances that kids abuse."

 

Almost 1 million youths aged 12 to 17 used some kind of inhalant in 2007, according to the study by the Department of Health and Human Services.

 

That represents 3.9 percent of adolescents, compared with about 1.1 million - or 4.4 percent _ in 2006.

 

The rate of "initiation," or teens trying inhalants for the first time, was also slightly lower in 2007 - 2.1 percent of teens, down from 2.4 percent in 2006.

 

Experts have attributed the drop to ongoing efforts to educate teens about the dangers of inhalant use and encourage parents to discuss the issue with their children.

 

But the rate of dependence and abuse was relatively stable from 2002 to 2007, with 0.4 percent of teens, or around 99,000 people, meeting the criteria for dependence or abuse.

 

Also, the study said that inhalants remain the third most-popular choice for teens trying drugs for the first time. In 2007 marijuana was the choice of 56.3 percent of first-time drug users; prescription drugs used recreationally were second at 23.5 percent; and inhalants were tried by 17.2 percent of first-time users.

 

The popularity of inhalants and marijuana dropped slightly for first-time users from 2006 to 2007 while prescription drugs grew slightly more prevalent as a first-time choice.

 

The findings were released at the kickoff of the 17th annual National Inhalants and Poisons Awareness Week. The National Inhalant Prevention Coalition scheduled a press conference to highlight the dangers of inhalants and urge steps to reduce their abuse, including designing air conditioners to restrict access to the refrigerant.

 

Attention from the 2007 death of a 19-year-old girl who sniffed air conditioner refrigerant helped produce a new model code for building air conditioner units that the National Inhalant Prevention Coalition wants states to adopt.

 

"While we cannot lock up common household products, we can put access to air conditioner refrigerants under lock and key to remove temptation," said Harvey Weiss, executive director of the coalition.

 

With a couple of exceptions, the specific types of inhalants teens turned to didn't change much in 2007 from years past. The most popular were gasoline, lighter fluid, glue and shoe polish, followed by spray paints and other aerosol sprays, and then correction and cleaning fluids and degreasers, and so-called "poppers," or nitrate inhalants.

 

Copyright 2009 Washington Times.

 

Poultry farmers upset at new EPA rules

 

Associated Press

Annapolis Capital

Monday, March 16, 2009

 

BALTIMORE (AP) - Some Maryland poultry farmers are upset that they will have to comply with federal pollution rules regarding chicken manure for the first time.

 

Environmental Protection Agency officials have informed farmers in a series of meetings o the Eastern Shore that they intend to enforce the rules. Farmers will have to get permits if any manure from their flocks is washing off their land into drainage ditches and streams.

 

State officials say more than half of Maryland's 800 poultry farmers have filed notices to get the permits.

 

Farmer David Wood of Caroline County describes the process as "a lot of red tape." He says he'll do what's necessary to comply but predicts that some smaller farmers may get out of the business.

 

The EPA says agriculture is the biggest source of nutrients that degrade the water quality of the Chesapeake Bay.

 

Copyright © 2009 | Capital Gazette Communications, Inc., Annapolis, Maryland.

 

National / International

 

Untreated adult ADHD raises some risks

 

By Liz Atwood

Baltimore Sun

Monday, March 16, 2009

 

Having trouble concentrating? Can't sit still? Are you disorganized and always late? If so, and if you've always been that way, it might not be a flaw in your personality but a genuine clinical disorder known as adult ADHD. Everyone's heard of attention deficit hyperactivity disorder in children, but left undiagnosed and untreated, it can carry over into adulthood, says Dr. David W. Goodman, assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and director of the Adult Attention Deficit Disorder Center of Maryland in Lutherville.

 

What are the symptoms of adult ADHD?

The core symptoms of ADHD are inattention, of which there are nine symptoms, and impulsivity and hyperactivity, of which there are nine symptoms. In order to reach the symptom criteria that makes one ADHD, the person has to have six of the nine symptoms of one and or both domains.

 

So although there are several ways it manifests itself, it is considered one disorder?

Yes. Because the response to treatment is virtually identical.

 

How common is ADHD?

About 8 percent of children have the disorder, of which 60 percent have been treated in the past year. Up to 65 percent will continue to have symptoms to an impairing degree in adulthood. That means the prevalence rate for adults is 4.4 percent - 9 million to 10 million adults in the United States, of which less than 15 percent have been treated in the past year.

 

Does adult ADHD manifest itself in ways different from childhood ADHD?

In children as they grow older, if they retain ADHD, the hyperactivity tends to diminish with age. The adults aren't going to be disruptively hyperactive, but they can be left with an internal sense of restlessness and being fidgety. Impulsivity can remain. But what becomes paramount in adults is the inattentiveness and disorganization. Also in children, the ratio of boys to girls [diagnosed with ADHD] is 3 to 1, because boys tend to show more signs of the disruptive behavior. But in adults, the ratio of males to females with ADHD is 1 to 1, as inattention becomes the symptom driving impairment.

 

When should someone see a doctor?

One should see a doctor if you have these symptoms, you've had them your whole life and it causes impairment. People who are unaware they have this may go to their doctor with symptoms of anxiety and depression. The physician doesn't think of querying for adult ADHD. It's why I think it should be part of every adult mental health evaluation. Its prevalence rate is higher than many mental health disorders physicians screen for. Because it is a newly recognized disorder, it hadn't been included in medical residencies, so a lot of physicians aren't able to recognize this condition.

 

What are the risks of undiagnosed ADHD in adults?

Developmentally, there are a lot of negative consequences of ADHD. There is a two-fold higher risk for cigarette smoking, two-fold risk for drug and alcohol abuse, higher risk for sexually transmitted disease, tenfold higher risk for unplanned pregnancy, a two to five times higher risk for motor vehicle accidents. [Adults with ADHD] are much more likely to lose jobs, impulsively quit or be fired. There is a higher rate of divorce.

 

How can you tell if someone has a real clinical disorder or if the person is just a goof-off?

Everyone has periods of times when they are distracted or put things off. That is not ADHD. ADHD is a group of these symptoms that occur on a daily basis to an impairing degree and have since childhood without change. The diagnosis is based on the current symptoms and how they have presented over the course of the individual's life.

 

Twenty years of medical research in adults have established this as a valid psychiatric condition. It's not a reflection of bad character or poor parenting. It is easy to say someone is lazy, stupid, not interested in the activity, or doing this to bother me. But if people are aware of ADHD, they may consider it the next time they encounter someone like this.

 

How is adult ADHD diagnosed?

By a comprehensive interview. By an assessment of the symptoms, age of onset of these symptoms, the course of those symptoms over one's life and level of impairment. You can have mild, moderate or severe ADHD. We look for impairment in multiple domains, such as school, work, family and social. And we look at whether there was an onset before age 7.

 

How do you get childhood information?

Most adults will not be able to recall symptoms prior to age 7. Most adults can recall symptoms between 7 and 12. The other thing I do is get a mother to fill out a rating scale for childhood ADHD symptoms. It's very helpful to increase the accuracy of that childhood history.

 

What causes ADHD?

It is thought to be related to neurotransmitters dopamine and norepinephrine, whose lower levels in the brain produce ADHD symptoms. ADHD is highly genetic. If you have a child with ADHD, the likelihood a parent is ADHD is 35 percent to 40 percent. If a parent has it, the likelihood a child will have it is 50 percent. The idea it is overdiagnosed and over-treated is not supported by research.

 

What are the treatment options?

A combination of therapies and medication. Medications recommended for adults are all once-a-day, long-acting medications that fall into two categories: stimulant medications and nonstimulant medications. The stimulant medications work quickly and improve focus, attention and concentration and decrease distractibility. As for the behavioral therapies, some people need organizational training or social skills training.

 

Are there risks for adults taking ADHD medications?

There are potential side effects, such as decreased appetite, headaches, insomnia, irritability, nausea and dry mouth. If the medication is dosed up slowly, those side effects can be minimized.

 

What about long-term side effects?

We don't know long-term side effects. One concern people have is the medication is going to change their personality. They worry they'll be zombies. Although some children have this experience, it has not been an issue in my adult patients. I tell my patients that if there are side effects, they should tell me so we can find a comfortable medicine for them. So, given the effective nature of these medications, people have to decide if the benefit of medication and quality of life merits staying on the medication.

 

Copyright © 2009, The Baltimore Sun/

 

Treatment for Peanut Allergies Shows Promise

 

By Tara Parker-Pope

New York Times

Monday, March 16, 2009

 

A medically supervised daily dose of peanuts may help children with peanut allergies greatly increase their tolerance to the food, according to two new studies that raise the possibility of a cure for this potentially life-threatening condition.

 

The findings, presented on Sunday at a meeting of the American Academy of Allergy, Asthma and Immunology in Washington, suggest that a treatment for peanut allergy may be developed in two or three years, said Dr. Wesley Burks, the chief of the division of pediatric allergy and immunology at Duke University Medical Center, who helped conduct the research.

 

An estimated 12 million Americans suffer from food allergies, including about 2.2 million children. About 3.3 million people are allergic to peanuts or tree nuts. While drugs can be used to treat an allergic reaction, there are no approved treatments for food allergies.

 

Because even a minor exposure can set off a reaction, many people at risk strictly avoid foods that contain an allergen or were prepared in places where nuts or other allergens might have been used. Symptoms range from mild stomach or skin reactions to a constriction of the airways.

 

Nearly half of the 150 deaths attributed to food allergies each year in the United States are caused by peanut allergies, according to Duke University.

 

The new treatment uses doses of peanuts that start as small as one-thousandth of a peanut and eventually increase to about 15 peanuts a day. In a pilot study at Duke University and Arkansas Children’s Hospital in Little Rock, 33 children with documented peanut allergy have received the daily therapy, which is given as a powder sprinkled on food. Most of the children are tolerating the therapy without developing allergic reactions, and five stopped the treatment after two and a half years because they could now tolerate peanuts in their regular diet. But four children dropped out because they could not tolerate the treatment.

 

In a related study of just 18 children, the researchers gave the treatment to 12 children and a placebo powder to 6. After 10 months, the children were given a medically supervised test exposing them to peanuts. In the placebo group, the children developed symptoms after ingesting the equivalent of one and a half peanuts. In the treatment group, the children tolerated 15 peanuts without symptoms.

 

Far more study is needed before the treatment can be used outside of a research setting, Dr. Burks said. The Duke/Arkansas study plans to enroll at least 80 children in the next few years to assess the treatment.

 

Researchers in Britain have reported similar results in small studies in which children were given daily peanut doses. The Consortium of Food Allergy Research, which includes five major research centers in the United States and is financed by the National Institute of Allergy and Infectious Diseases, is conducting similar treatment studies for both egg and peanut allergies.

 

Dr. Burks said that the children in the studies were under a high level of medical supervision, and that parents should not try the approach on their own.

 

Copyright 2009 New York Times.

 

Analysis: Stem cell payoff wait's decades not days

 

Associated Press

By Lauran Neergaard

Washington Post

Monday, March 16, 2009

 

WASHINGTON -- For all the past week's headlines about embryonic stem cells' medical promise there is a sobering reality: The science to prove that promise will take years, probably too long for many of today's seriously ill.

 

On his desk at Children's Hospital Boston, Harvard stem cell researcher Dr. George Daley keeps a file about 3 inches thick of e-mails and letters from patients and families who hope his work could help them. They are both inspiration and caution.

 

"It took much of the 20th century to figure out how to deliver chemicals as drugs," noted Daley. "We should be humble and appreciate it may take us the better part of this century to truly harness the power of cells as medicines."

 

Nor is there any way to know which kinds of cells ultimately will work - embryo-derived ones that elicit heated moral debate, or some of the many other types of stem cells that scientists are studying furiously.

 

President Barack Obama last week lifted restrictions on taxpayer funding of research using human embryonic stem cells, widening the field. The Bush administration had limited taxpayer money for that research to a small number of stem cell "lines," or groups that were created before Aug. 9, 2001, lines that in many cases had drawbacks that limited their potential use.

 

Make no mistake: Federal law forbids taxpayer money from being used to create or destroy embryos, and only Congress could change that, considered unlikely.

 

The National Institutes of Health now is developing guidelines on what kinds of stem cell studies will be allowed. The rules are due in July.

 

It's a young science to be so contentious. University of Wisconsin scientists culled the first human embryonic stem cells - from an embryo no bigger than the period at the end of this sentence - a mere decade ago. They're prized because they can turn into any cell of the body. If scientists could control that metamorphosis, they might create replacement tissue to treat a variety of diseases and conditions, from diabetes to Parkinson's to the paralysis of spinal cord injury.

 

But that initial culling of the cells does kill the days-old embryo. So critics say using the resulting stem cells - which can propagate in lab dishes indefinitely - makes taxpayers who are morally opposed to embryo research complicit in it.

 

There are various alternatives. Different types of stem cells can come from fetuses and placenta, blood and bone marrow. So-called "adult" stem cells that already have matured to create a given tissue-type aren't considered as flexible as embryonic ones, although some recently discovered in men's testicles seem close.

 

Then there are recently developed "reprogrammed" stem cells where scientists take, say, an ordinary skin cell and slip genes inside it to turn back the clock and make it embryonic-like again. If those so-called iPS cells truly prove to be as flexible as they appear, they could remove the moral debate - and even leading embryonic stem cell scientists hope that happens.

 

Meanwhile, critics argue that adult stem cells already can cure people. Indeed, what people once called "bone-marrow transplants" are injections of stem cells destined to grow blood and immune-system cells, and they do treat various blood and immune disorders.

 

But taking a stem cell destined to produce blood and making it grow heart muscle or nerves instead is very different, stressed Dr. John Gearhart of the University of Pennsylvania.

 

Adult stem cell injections temporarily helped heart-failure patients a few years ago. The new cells didn't grow but for a few months secreted substances that helped what was left of the old scarred heart tissue work a little better, he said. New attempts using different stem cells are under way now.

 

Spinal cord injury may be more amenable to stem cell therapy than diseases that could overtake and damage newly implanted cells. Stem cells have helped paralyzed rodents move again by repairing insulation lost around damaged nerves. In the first attempt at an embryonic stem cell therapy this summer, Geron Corp. will test if a few recently paralyzed people react similarly.

 

Last week another California company, DaVinci Biosciences, reported injecting a few paralyzed patients in Ecuador with stem cells from their own bone marrow. The researchers reported no side effects and recorded some signs of improvement in movement and bladder function two years later, although there was no way to know if that was due to the stem cells.

 

Scientists long thought Type 1 diabetes might be the easiest disease for stem cells to tackle. After all, some patients today do well with transplants of donated insulin-producing cells. But Gearhart said it's proving hard to grow pancreatic cells from any sort of stem cell. They seem to be missing compounds essential for their survival.

 

"It's the whole neighborhood" that may have to be recreated, he said.

 

Desperate patients don't always recognize those hurdles, laments Gearhart - who has tried to dissuade some heading overseas to clinics advertising stem cell "cures." Just last month, Israeli doctors reported the sad case of a 9-year-old with a fatal brain-disease whose parents carried him to Russia for injections of purported fetal stem cells. Not only did the injections not help, they apparently triggered a brain tumor discovered four years later.

 

"You try to give the message there of caution, caution, caution," Gearhart said.

 

EDITOR's NOTE _ Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

 

© 2009 The Associated Pressa.

 

Possible therapy takes bite out of peanut allergy

 

Associated Press

By Lauran Neergaard

Washington Post

Sunday, March 15, 2009

 

WASHINGTON -- Scientists have the first evidence that life-threatening peanut allergies may be cured one day.

 

A few kids now are allergy-free thanks to a scary treatment - tiny amounts of the very food that endangered them.

 

Don't try this at home. Doctors monitored the youngsters closely in case they needed rescue, and there's no way to dice a peanut as small as the treatment doses required.

 

But over several years, the children's bodies learned to tolerate peanuts. Immune-system tests show no sign of remaining allergy in five youngsters, and others can withstand amounts that once would have left them wheezing or worse, scientists reported Sunday.

 

Are the five cured? Doctors at Duke University Medical Center and Arkansas Children's Hospital must track them years longer to be sure.

 

"We're optimistic that they have lost their peanut allergy," said the lead researcher, Dr. Wesley Burks, Duke's allergy chief. "We've not seen this before medically. We'll have to see what happens to them."

 

More rigorous research is under way to confirm the pilot study, released Sunday at a meeting of the American Academy of Allergy, Asthma and Immunology. If it pans out, the approach could mark a major advance for an allergy that afflicts 1.8 million people in the United States.

 

For parents of these little allergy pioneers, that means no more fear that something as simple as sharing a friend's cookie at school could mean a race to the emergency room.

 

"It's such a burden lifted off your shoulder to realize you don't have to worry about your child eating a peanut and ending up really sick," said Rhonda Cassada of Hillsborough, N.C. Her 7-year-old son, Ryan, has been labeled allergy-free for two years and counting.

 

It's a big change for a child who couldn't tolerate one-sixth of a peanut when he entered the study at age 2 1/2. By 5, Ryan could eat a whopping 15 peanuts at a time with no sign of a reaction.

 

Not that Ryan grew to like peanuts. "They smell bad," he said matter-of-factly.

 

Millions of people have food allergies and peanut allergy is considered the most dangerous, with life-threatening reactions possible from trace amounts. It accounts for most of the 30,000 emergency-room visits and up to 200 deaths attributed to food allergies each year. Although some children outgrow peanut allergy, that's rare among the severely affected.

 

There's no way to avoid a reaction other than avoiding peanuts. Those allergy shots that help people allergic to pollen and other environmental triggers reduce or eliminate symptoms - by getting used to small amounts of the allergen - are too risky for food allergies.

 

Enter oral immunotherapy.

 

Twenty-nine severely allergic children spent a day in the hospital swallowing minuscule but slowly increasing doses of a specially prepared peanut flour, until they had a reaction. The child went home with a daily dose just under that reactive amount, usually equivalent to one-thousandth of a peanut.

 

After eight months to 10 months of gradual dose increases, most can eat the peanut-flour equivalent of 15 peanuts daily, said Burks, who two years ago began reporting these signs of desensitization as long as children took their daily medicine.

 

Sunday's report goes the next big step.

 

Nine children who had taken daily therapy for 2 1/2 years were given a series of peanut challenges. Four in the initial study report - and a fifth who finished testing last week - could stop treatment and avoid peanuts for an entire month and still have no reaction the next time they ate 15 whole peanuts. Immune-system changes suggest they're truly allergy-free, Burks said.

 

Scientists call that tolerance - meaning their immune systems didn't forget and go bad again - and it's a first for food allergy treatment, said Dr. Marshall Plaut of the National Institutes of Health.

 

"Anything that would enable kids to eat peanuts would be a major advance," Plaut said, cautioning that more study is needed. "This paper, if it's correct, takes it to the next level. ... That is potentially very exciting."

 

Arkansas Children's Hospital has begun a study randomly assigning youngsters to eat either peanut flour or a dummy flour. It's not over, but after the first year, the treated group ate the equivalent of 15 peanuts with no symptoms while the placebo group suffered symptoms to the equivalent of a single peanut, Burks said.

 

The treatment remains experimental, Burks stressed, although he hopes it will be ready for prime time in a few years.

 

He isn't taking chances with the first five allergy-free kids. They're under orders to eat the equivalent of a tablespoon of peanut butter a day to keep their bodies used to the allergen.

 

Ryan Cassada says his mom sometimes "hides them in things so she can force me to eat it." Peanut butter cookies are OK, he says, just not straight peanut butter.

 

The battle is a small price, his mother said. "As much as I can get into him is fine with me. It's huge knowing he won't have a reaction."

 

On the Net:

American Academy of Allergy, Asthma and Immunology:http://www.aaaai.org/

 

© 2009 The Associated Press.

 

Opinion

 

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